Oscar Lederman

The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis

OBJECTIVE People with posttraumatic stress disorder (PTSD) have a higher mortality than the general population, mainly due to cardiovascular diseases (CVD). Metabolic syndrome (MetS) and its components are highly predictive of CVD. The aim of this meta-analysis was to describe pooled frequencies of MetS and its components in people with PTSD and to compare MetS prevalence in PTSD versus the general population. METHOD Medline, PsycARTICLES, Embase and CINAHL were searched until 02/2015 for cross-sectional and baseline data of longitudinal studies in adults with PTSD. Two independent reviewers conducted the searches and extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed. RESULTS Overall, 9 studies met the inclusion criteria including 9,673 individuals in midlife with PTSD and 6852 general population controls. The pooled MetS prevalence was 38.7% (95% CI = 32.1%-45.6%; Q = 52.1, p < 0.001; N = 9; n = 9,673; age range = 44-61 years). Abdominal obesity was observed in 49.3% (95% CI = 29.7%-69.0%), hyperglycemia in 36.1% (95% CI = 18.8%-55.6%), hypertriglyceridemia in 45.9% (95% CI = 12.2%-81.9%), low high density-lipoprotein-cholesterol in 46.4% (95% CI = 26.4%-67.0%) and hypertension in 76.9% (95% CI = 67.9%-84.8%). The MetS prevalence was consistently high across geographical regions, settings or populations (war veterans or not). Compared with matched general population controls, people with PTSD had an almost double increased risk for MetS (RR = 1.82; 95% CI = 1.72-1.92; p < 0.001). Most analyses were not statistically heterogeneous. CONCLUSIONS MetS is highly prevalent in people with PTSD. Routine screening and multidisciplinary management of medical and behavioral conditions is needed. Future research should focus on how cardio-metabolic outcomes are moderated by clinical and treatment characteristics and genetic factors.

Consensus statement on the role of Accredited Exercise Physiologists within the treatment of mental disorders: a guide for mental health professionals.

Objective: The aim is to identify the role and scope of Accredited Exercise Physiologist (AEP) services in the mental health sector and to provide insight as to how AEPs can contribute to the multidisciplinary mental health team. Methods: A modified Delphi approach was utilised. Thirteen AEPs with experience in mental health contributed to the iterative development of a national consensus statement. Six mental health professionals with expertise in psychiatry, mental health nursing, general practice and mental health research participated in the review process. Reviewers were provided with a template to systematically provide feedback on the language, content, structure and relevance to their professional group. Results: This consensus statement outlines how AEPs can contribute to the multidisciplinary mental health team, the aims and scope of AEP-led interventions in mental health services and examples of such interventions, the range of physical and mental health outcomes possible through AEP-led interventions and common referral pathways to community AEP services. Outcome: AEPs can play a key role in the treatment of individuals experiencing mental illness. The diversity of AEP interventions allows for a holistic approach to care, enhancing both physical and mental health outcomes.

Type 2 diabetes among people with posttraumatic stress disorder: systematic review and meta-Analysis

Objective To clarify the prevalence and predictors of Type 2 diabetes mellitus (T2DM) in people with posttraumatic stress disorder (PTSD) and where possible compare this to healthy controls. Methods We searched major electronic databases until May 2015 for studies reporting T2DM prevalence in people with PTSD. Two independent authors extracted data and completed methodological quality appraisal. A random-effects meta-analysis was used. Results From 1171 candidate publications after exclusions, nine publications were included (n = 23,396; 28.6% male; mean age = 35–60 years). The overall prevalence of T2DM was 10.0% (95% confidence interval [CI] = 8.1%–12.0%). Subgroup analysis demonstrated that war veterans experience higher prevalence of T2DM (16.3%; 95% CI = 5.2%–31.8%; n studies = 3, n = 473) compared with mixed samples (11.8%; 95% CI = 6.34–18.7, p < .001; n studies = 4, n = 2753). Increasing age (&bgr; = 0.0593, 95% CI = 0.010–0.109, z = 2.34, p = .019), median year of publication (&bgr; = −0.08, 95% CI = −0.14 to −0.03, z = −3.09, p = .002), and a lower percentage of white participants (&bgr; = −3.21, 95% CI = −5.12 to −1.29, z = −2.28, p = .001) predicted prevalence of T2DM. A relative risk meta-analysis comparing controls (n = 125,723) against those with PTSD (n = 23,203) demonstrated a significantly increased risk of T2DM (n studies = 5, relative risk = 1.49, 95% CI = 1.17–1.89, p = .001). Conclusions People with PTSD are at a high risk for developing T2DM. The current findings should, however, be interpreted with caution because most studies were based on self-report data.

How can we increase physical activity and exercise among youth experiencing first‐episode psychosis? A systematic review of intervention variables

To review intervention variables and outcomes of studies designed to increase physical activity or exercise participation among people experiencing first‐episode psychosis.

Is autonomous motivation the key to maintaining an active lifestyle in first-episode psychosis?

Physical activity has the potential to improve the health of patients with first‐episode psychosis (FEP), yet many patients with FEP remain inactive. Exploring the theoretical basis of the motivational processes linked to the adoption and maintenance of physical activity behaviours in FEP patients can assist with the design and delivery of physical activity interventions. Within the self‐determination theory and the transtheoretical model (stages of change) frameworks, we investigated motives for physical activity adoption and maintenance in FEP.

How can we increase physical activity and exercise among youth experiencing first-episode psychosis?

To review intervention variables and outcomes of studies designed to increase physical activity or exercise participation among people experiencing first‐episode psychosis.

Embedding exercise interventions as routine mental health care: implementation strategies in residential, inpatient and community settings

Objectives: Evaluation of physical activity (PA) programs among populations with severe mental illness (SMI) has predominately focused on efficacy and therapeutic benefits. There is now strong evidence to support the benefits of PA in people with SMI. What remains is a gap in the implementation of pragmatic and sustainable PA interventions in mental-health settings. The current paper provides examples of interventions that have been successfully implemented in Australian settings, identifies key components of successful PA interventions and outlines practical strategies that can assist with widespread implementation of PA interventions in mental-health settings. Conclusions: There is an emergence of PA interventions being imbedded within a variety of mental-health settings. These interventions vary in terms of mode and intensity of service delivery. Yet, all aim to increase PA and reduce sedentary behaviour. Adopting the identified strategies may help facilitate successful implementation and increase access to PA interventions for mental-health service users.

Implementation in action: how Australian Exercise Physiologists approach exercise prescription for people with mental illness

Abstract Background: Accredited Exercise Physiologists (AEPs) are trained to deliver exercise and physical activity interventions for people with chronic and complex health conditions including those with mental illness. However, their views on exercise for mental illness, their exercise prescription practices, and need for further training are unknown. Aims: To examine the way in which Australian AEPs prescribe exercise for people with mental illness. Methods: Eighty-one AEPs (33.3 ± 10.4 years) completed an online version of the Exercise in Mental Illness Questionnaire. Findings are reported using descriptive statistics. Results: AEPs report a high level of knowledge and confidence in prescribing exercise for people with mental illness. AEPs rate exercise to be at least of equal value to many established treatments for mental illness, and frequently prescribe exercise based on current best-practice principles. A need for additional training was identified. The response rate was low (2.4%) making generalisations from the findings difficult. Conclusions: Exercise prescription practices utilised by AEPs are consistent with current best-practice guidelines and there is frequent consultation with consumers to individualise exercise based on their preferences and available resources. Further training is deemed important.

Modifiable cardiometabolic risk factors in youth with at-risk mental states: A cross-sectional pilot study

Young people experiencing psychotic illness engage in low amounts of physical activity have poor fitness levels and poor sleep quality. This study aimed to determine the prevalence of these modifiable cardiometabolic risk factors among individuals with at-risk mental states (ARMS), who are at increased risk of developing psychosis. A cross-sectional study was conducted in a community-based youth mental health service. Thirty participants (23%♀, 21.3 ± 1.7 years old) were recruited, 10 with ARMS, 10 with first-episode psychosis (FEP) and 10 healthy volunteers. Physical activity levels were assessed using self-report and objective measures. Aerobic capacity, upper body strength, hamstring flexibility, forearm grip strength and core endurance were assessed. Sleep quality, depression and anxiety were measured by self-report questionnaire. The ARMS group did not differ significantly on anthropometric measures from FEP or healthy volunteers. They engaged in significantly less physical activity (p < 0.05) and had poorer sleep quality (p < 0.05) than healthy volunteers. Our results are consistent with other studies that found that youth with ARMS are at greater cardiometabolic risk. Interventions aimed at improving these modifiable risk factors may assist with preventing the decline in physical health associated with the development of psychiatric illness.

Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients

OBJECTIVE To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. METHODS Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. RESULTS Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated. CONCLUSIONS Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.